ʻO ka tracheostomy kahi wehe ʻokiʻoki o ka trachea e hoʻomaikaʻi i ka ea me ka hoʻohana ʻana i kahi ventilator. Hiki ke hoʻokō ʻia kēia hana i kekahi mau kūlana a i ka mālama koʻikoʻi. 

ʻO kahi tracheostomy ka hana ʻana i kahi puka liʻiliʻi i loko o ka larynx a hoʻokomo i kahi cannula liʻiliʻi i loko, e hoʻomaikaʻi ai i ka ea (komo a me ka puka ʻana o ka ea i loko o ka māmā), me ka mīkini a ʻole. ʻAʻole kēia hana i ka ʻōpū hanu luna (ihu a me ka waha). ʻAʻole pono e hele hou ka ea ma ka ihu a i ʻole ka waha e hiki ai i ka māmā. Hiki i ka tracheostomy ke noho mau a no ka manawa pōkole.

Hoʻomākaukau no kahi tracheostomy

Ke hoʻokō ʻole ʻia ka tracheostomy i kahi pōʻaiapili pilikia, ma mua o ke kūkākūkā ʻana i ka anesthesia. 

Pehea e hana ʻia ai kahi tracheostomy?

Hiki ke hana ʻia kahi tracheostomy ma lalo o ka anesthesia āpau a i ʻole ma lalo o ka anesthesia kūloko.

No kahi tracheostomy oki, hana ʻia kahi ʻoki ma ka pae o ka trachea ma waena o nā apo cartilage 2 a me 4. Hoʻokomo ʻia kahi cannula tracheostomy i loko o ka trachea ma o kēia puka.

Hana ʻia kahi tracheostomy percutaneous ma lalo o ka anesthesia kūloko, i kekahi manawa me ka hoʻomaha hou ʻana, ma ka ʻaoʻao moe o ka mea maʻi i ka mālama koʻikoʻi a ʻaʻole i loko o ke keʻena ʻoki. I kēia hihia, ʻaʻohe ʻili ʻili. Huʻi ʻia ka trachea me ka nila. Hoʻohana ʻia kēia nila no ka hele ʻana i kahi alakaʻi ʻoʻoleʻa kahi i hoʻokomo ʻia ai nā dilator nui a nui a hiki i ke anawaena o ka cannula. 

I nā pilikia ulia pōpilikia, hiki ke hana ʻia kahi tracheostomy ma lalo o ka anesthesia kūloko ma waho o ka lumi hana.

Hōʻike ʻia ka tracheostomy provisional i ka wikiwiki loa i nā hihia o ke ala ala ea kiʻekiʻe (asphyxia) ke hiki ʻole ke hoʻokomo ʻia ka tracheal intubation a i ʻole contraindicated.

Hiki ke hana ʻia kahi tracheostomy no ka hoʻomākaukau ʻana no ka ʻoki ʻana i ka laryngeal a i ʻole ka pharyngeal, e lanakila ai i ka intubation paʻakikī i ka wā o ka anesthesia, e ʻae i ka hoʻokuʻu ʻana i ka mechanical lōʻihi i ke kanaka i ka mālama koʻikoʻi. 

Hiki ke hana ʻia kahi tracheostomy i nā poʻe me ka hanu ʻana o ka hanu maʻamau, inā he anomaly waena a peripheral paha o ka hui oropharyngeal (mouth-pharynx) me nā maʻi ʻai a i ʻole nā ​​​​maʻi neuromuscular (e like me ka myopathy) kahi e nāwaliwali ai ka maʻi. ʻo nā ʻiʻo hanu a i ʻole kahi kīnā i ko lākou mana e hōʻemi i ka maikaʻi o ka hanu a pono ke kōkua ventilatory. 

ʻAʻole i manaʻo ʻia he ʻeha nā hopena o kēia hana. Hoʻohana ʻia nā analgesics ma hope o ka hana e hoʻomaha i ka ʻeha. I nā lā mua, hiki i ka cannula ke hoʻonāukiuki a i ʻole ke kumu o ka ʻuhū reflex. He mau lā e hoʻomaʻamaʻa ʻia i kahi paipu tracheostomy a he mau pule e ʻike ʻole ai. ʻAʻole hiki i kahi tracheostomy ke pale i ka ʻōlelo a me ka ʻai ʻana me kekahi mau hoʻololi. 

Noho me kahi tracheostomy

Ke ʻike maopopo ʻia ka tracheostomy (i ka wā o ka hiki ʻole o ka hanu maʻi maʻi a i ʻole ka maʻi neuromuscular, no ka laʻana), ʻike ʻia ka tracheotomy ma ke ʻano he pae paʻakikī. ʻo kona kūpaʻa kino, ka manaʻolana o ka noho ʻana me ka ʻoi aku ka paʻakikī. Eia naʻe, lawe mai ia i nā pōmaikaʻi. ʻOi aku ka ʻoluʻolu o ka hanu ʻana me kēia ventila invasive ma mua o ka ventila non-invasive. 

Ke aʻo aku nei nā limahana olakino i nā maʻi tracheostomy a me ka poʻe e pili ana iā lākou i ka mālama e pono ai: hoʻololi i ka cannula, mālama i ka puka o ka trachea, aspiration endotracheal… Hiki iā lākou ke aʻo i ka poʻe a puni lākou e hana i kēia mālama. 

E `ike : I ka wā lōʻihi o ka tracheostomy, ʻo ka wehe ʻana i ka cannula e hiki ai i ka wehe ʻana o ka pharynx ke pani i loko o nā lā.